HomeMy WebLinkAboutExhibit D- Disclosure of Lobbying ActivitiesEXHIBIT "D"
DISCLOSURE OF LOBBYING ACTIVITIES
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
64-i'
015'. Contract
Ea e' Bid /offer /application
initial filing
b. Grant
b. Initial award
b. Material change
c. Cooperative agreement
c. Post -award
For Material Change Only:
d. Loan
Year Quarter
e. Loan guarantee
Date of last report
f. Loan insurance
4. Nanj"nd Address of Reporting Entity:
5. If Reporting Entity in No. 4 is Subawardee. Enter Name
Prime ❑ Subawardee
and Address of Prime:
UN 1 JF tR'; V 600-P, Tier if known
ongressibnal District, if known:
Congressional District, if known:
6. Federal Department/Agency:
7. Federal Program Name /Description:
CFDA Number, if applicable
8. Federal Action Number, if known:
9. Award Amount, if known:
10. Name and Address of Lobbying Entity
b. Individuals Performing Services (including address if
(If individual, last name, first name, MI):
different from No. 10a)
(Last name, first name, MI):
11. Information requested through this form is authorized by Title
Signature:
31 U.S.C. Section 1352. This disclosure of lobbying activities is a
Print Name: =
material representation of fact upon which reliance was placed by
the tier above when this transaction was made or entered into.
This disclosure is required pursuant to 31 U.S.C. 1352. This
Title: -- _4 E i
C10
information will be reported to the Congress semi - annually and will
fails to file the
be available for public inspection. Any person who
Telephone No.: Date:
required disclosure shall be subject to a civil penalty of not less
than $10,000 and not more than $100,000 for each such failure.
Federal Use Only:
Authorized for Local Reproduction
Standard Form — LLL Rev. 7 -97
Standard Form LLL Rev. Uti -U4 -9U
FARequest for Proposal tech center mod.doc
VENDORS PROPOSAL AND COMPENSATION STATEMENTS
VENDORS PROPOSAL AND COMPENSATION STATEMENTS
A. We, UniFirst Corporation agree that this RFP shall be incorporated in its entirety as a
part of our proposal. - ( �, manager).
-ter- � ,, �_____ sales mana er .
B. This RFP and UniFirst Corporation proposal will jointly become part of the agreement for
services for the Employee Uniform Program when said agreement is fully executed by
UniFirst Corporation and the Mayor or City Manager of Lake Elsinore.
(sales manager).
C. Unifirst Corporation Services to be provided, and fees therefor, will be in accordance
with the City's RFP except as otherwise specified in UniFirst Corporation proposal under
the heading "ADDITIONS OR EXCEPTIONS TO THE CITY'S REQUEST FOR PROPOSAL."
- (sales manager).
D. A single and separate section with the heading "ADDITIONS OR EXCEPTIONS TO THE
CITY'S REQUEST FOR PROPOSAL" containing a complete and detailed description of all of
the exceptions to the provisions and conditions of this Request for Proposal upon which
UniFirst Corporation Proposal is contingent and which shall take precedent over this RFP
�- (sales manager).
E. A listing of recent similar services completed or currently under contract including the
names, titles, addresses and telephone numbers of the appropriate persons whom the
City could contact. (sales manager).
F. UniFirst Corporation agrees that we will not discriminate against any employee or
applicant for employment because of race, color, religion, sex, or national origin.
sa es manager).
G. UniFirst Corporation agrees that all federal laws and regulations shall be adhered to
notwithstanding any state or local laws and regulations. In a case of conflict between
federal, state or local laws or regulations the strictest shall be adhered to.
(sales manager).
H. UniFirst Corporation shall allow all authorized federal, state, county, and City officials
access to place of work, books, documents, papers, fiscal, payroll, materials, and other
relevant contract records pertinent to this service. All relevant records shall be retained
for at least three years. (sales manager).
I. UniFirst Corporation shall comply with the Davis -Bacon Fair Labor Standards Act (40 USC
276 -a through a -7), and the implementation regulations issued pursuant thereto (29
CFR Section 1,5), any amendments thereof and the California Labor Code. Pursuant to
the said regulations, entitled "Federal Labor Standards Provisions," Federal Prevailing
Wage Decision" and State of California prevailing wage rates, respectively.
- -. - (sales manager).
J. UniFirst Corporation shall comply with the Copeland Anti - Kickback Act (18 USC 874) and
the Implantation Regulation (29 CFR 3) issued pursuant thereto, and any amendments
thereof. - (sales manager).
K. UniFirst Corporation offers and agrees to assign to the City all rights, title, and interest in
and to all causes of action it may have under section 4 of the Clayton Act (15 USC Sec.
15) or under the Cartwright Act (Chapter 2 {commencing with section 167001 of Part 2
of Division 7 of the Business and Professions Code), arising from purchase of goods,
services, or materials pursuant to the public works or the subcontract. This assignment
shall be made and become effective at the time the city tenders final payment to
UniFirst Corporation, without further acknowledgement by the parties.
(sales manager).
L. Complete Disclosure of Lobbying Activities. (sales
manager).